ASSESSING FETAL WELL-BEING

* Fetal Heart Rate

- can already be heard on the 10th-11th week of pregnancy through a Doppler

- 120-160 bpm

* Daily Fetal Movement Count (Kick Counts)

- “Quickening” is the fetal movements being felt by the mother.

- Occurs as early as 18-20 weeks and at peak on the 28th-38th week of pregnancy

- A healthy fetus moves at about 10 times per hour.

* Rhythm Strip Testing

- assessment of fetal well being and assesses the fetal heart rate for a normal baseline rate.

- baseline reading refers to the average rate of the fetal heart beat

- Variability:

a. Absent - No peak-to-trough range detectable

b. Minimal - 5 beats/min or fewer

c. Moderate / Normal - 6 to 25 bpm

d. Marked - greater than 25 bpm

* Non-stress Testing

- measures the response of fetal heart rate to fetal movement

- when a fetus moves, fetal heart rate must increase at approximately 15 bpm and remain elevated
for 15 seconds

- If there’s no fetal heart rate increase on fetal movement, further assessment is necessary

- Rhythm Strip Test and Non-stress Test are non-invasive procedures and cause no risk to either the
pregnant woman or fetus, they can be used as screening procedures in all pregnancies.
* Vibro-acoustic Stimulation

- an acoustic stimulator is applied on the pregnant woman’s abdomen to produce a sharp sound of
approximately 80 dB at frequency of 80 Hz, thus startling and waking the fetus.

- this test is usually done if a spontaneous acceleration in fetal heart rate has not occurred within 5
minutes.

* Ultrasonography

- measures the response of sound waves against solid objects, much-used tool for fetal assessment

- used to:

A. Diagnose pregnancy as early as 6 weeks of gestation

B. Confirm the presence, size, and location of the placenta and amniotic fluid.

C. Establish the sex if a penis is revealed

D. Establish the presentation and position of the fetus

E. Predict gestational age

F. Discover complications of pregnancy

* Biparietal Diameter

- side-to-side measurement of the fetal head

- 80% of pregnancies the biparietal diameter of the fetal head is 8.5 cm or greater, with this it can be
predicted that the infant will weigh more than 2,500g (5.5lbs) at birth or is at a fetal age of 40 weeks.

* Doppler Umbilical Velocimetry

- measures the velocity at which red blood cells in the uterine and fetal vessels travel.

- assessment of the blood flow through uterine blood vessels is helpful to DETERMINE THE
VASCULAR RESISTANT PRESENT IN WOMAN WITH GESTATIONAL DIABETES OR HYPERTENSION AND
WHETHER RESULTANT PLACENTAL INSUFFICIENCY IS OCCURRING.

* Placental Grading for Maturity

- placentas can be graded by ultrasound based on the particular amount of calcium deposits present
in the base:

> 0: between 12 and 24 weeks

 > 1: 30-32 weeks

> 2: 36 weeks

> 3: 38 weeks ( because fetal lungs are apt to be mature by 38 weeks, a grade 3 placenta suggests
fetus is mature ).

* Amniotic Fluid Volume

- amniotic fluid volume is another way to estimate fetal health because a portion of the fluid is
formed by fetal kidney output.

- if a fetus is becoming so stressed in utero that circulatory and kidney function is failing, urine
output, and, consequently, the volume of amniotic fluid will decrease.

- A DECREASE IN AMNIOTIC FLUID VOLUME PUTS THE FETUS AT RISK FOR COMPRESSION OF THE
UMBILICAL CORD WITH INTERFERENCE OF NUTRITION AS WELL AS LACK OF ROOM TO EXERCISE AND
MAINTAIN MUSCLE TONE.

- Hydramnios is the excessive fluid caused by inability of the fetus to swallow. (Amniotic fluid of
greater than 20-24 cm)

- Oligo-hydramnios is the decreased amniotic fluid caused by poor perfusion and kidney failure. ( AF
less than 5-6 cm)

* Nuchal Translucency

- The unusual pockets of fat or fluid present in the posterior neck of children seen through a
sonogram

* Biophysical Profile

- combines five parameters : fetal reactivity, fetal breathing movements, fetal body movements,
fetal tone, and amniotic fluid volume)

- The fetal heart and breathing record measures short-term central nervous system function

- The amniotic fluid volume helps measure long-term adequacy of placental function

- 10 will be the highest possible score. Since this is similar to APGAR scoring determined at birth on
infants, it is often referred to as fetal Apgar score.
* Magnetic Resonance Imaging

- MRI has the potential to replace or complement ultrasonography as a fetal assessment technique
because it can identify structural anomalies or soft tissue disorders.

- most helpful in diagnosing complications such as ectopic pregnancy or trophoblastic disease

because later in a pregnancy, fetal movement can obscure the findings.

* Maternal Serum a-Fetoprotein

- AFP is a substance produced by the fetal liver that can be found in both amniotic fluid and
maternal serum.

- The level is abnormally high if the fetus has an open spinal or abdominal wall defect because the
open defect allows more AFP to enter the mother’s circulation than usual.

- The level is low if the fetus has a chromosomal defect such as Down Syndrome

- 80% of pregnancies of babies with Down Syndrome can be detected by this method

* Maternal Serum for Pregnancy-Associated Plasma Protein A

- a protein secreted bu the placenta

- low levels in maternal blood are associated with fetal chromosomal anomalies, or small-for-
gestational-age

- high levels of PAPP-A may predict an LGA baby

* Quadruple Screening

- analyzes four indicators of fetal health : AFP , Unconjugated Estriol (UE is an enzyme produced by
the placenta that estimates general well-being) , Human Chorionic Gonadotropin (hCG is produced by
the placenta) , and Inhibin A ( a protein produced by the placenta and corpus luteum associated with
Down syndrome )

* Fetal Gender

- usually determined by an ultrasound screen at about 4 months.

- It can also be determined as early as 7 weeks by analysis of maternal serum.

- Early diagnosis can be helpful to a woman who has an X-carrying genetic disorder so she could
discover if she has a male fetus who could inherit the disease or a female fetus who will be disease-free.

* Invasive Fetal Testing

- Chorionic Villi Sampling

- Amniocentesis- a pocket of amniotic fluid is located by sonogram. A small amount of fluid is

removed by needle aspiration.